Healthcare Provider Details

I. General information

NPI: 1235768359
Provider Name (Legal Business Name): MICHAEL D SEIGLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-9800
US

IV. Provider business mailing address

16853 CECIL PL
RIVERSIDE CA
92504-6203
US

V. Phone/Fax

Practice location:
  • Phone: 951-765-4848
  • Fax:
Mailing address:
  • Phone: 951-312-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number176528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: